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Outcomes for popliteal artery injury repair after discharge

A large-scale population-based analysis

Butler, William J. MD; Calvo, Richard Y. PhD; Sise, Michael J. MD; Bowie, Jason M. MD; Wessels, Lyndsey E. MD; Bansal, Vishal MD; Beth Sise, C. MSN

Journal of Trauma and Acute Care Surgery: February 2019 - Volume 86 - Issue 2 - p 173–180
doi: 10.1097/TA.0000000000002118
AAST 2018 PODIUM PAPER
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BACKGROUND Although short-term outcomes for popliteal artery injury after endovascular versus open repair appear similar, studies on outcomes after discharge are limited. We evaluated popliteal artery injury repair in a population-based data set. We hypothesized that postdischarge outcomes for open repair are superior to endovascular repair.

METHODS Patients with popliteal artery injury were identified in the California Office of Statewide Health Planning and Development 2007–2014 discharge database. Popliteal artery injury and other lower-extremity injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Procedure codes were evaluated to identify open repair, endovascular repair, fasciotomy, and amputation. Primary outcomes were mortality or amputation. The association between repair method and each outcome was evaluated with logistic regression. Postdischarge amputation and all-cause mortality were evaluated using survival analysis.

RESULTS Among 769 patients with popliteal artery injury, open repair occurred in 456 (59.3%), endovascular repair in 37 (4.3%), combined endovascular and open in 18 (2.3%), and nonoperative management in 258 (33.6%). Fasciotomy was performed more frequently in open than endovascular repair (p = 0.001) during index admission. Amputation rate was also increased in open repair, but this was not significant (p = 0.196). Arterial thromboembolus during index admission was more likely after endovascular or combined endovascular and open compared with open (24.3%, 55.6%, 16.7%, respectively, p < 0.001). Patients requiring both endovascular and open were more likely to undergo amputation postdischarge (hazard ratio, 4.11; 95% confidence interval, 1.16–14.53). Patients undergoing endovascular repair were more likely to die postdischarge (hazard ratio, 4.43; 95% confidence interval, 1.06–18.56) compared with patients who had open repair (median, 98.5 days postdischarge).

CONCLUSIONS In a large cohort with popliteal artery injury, open repair was associated with lower rates of index admission arterial thromboembolus as well as postdischarge amputation and all-cause mortality. We recommend conducting a prospective multicenter study to examine the appropriate use of endovascular repair for this injury.

LEVEL OF EVIDENCE Therapeutic, level IV.

From the Trauma Service (W.J.B., R.Y.C., M.J.S., J.M.B., L.E.W., V.B., C.S.), Scripps Mercy Hospital, San Diego, California.

This study was presented at the 77th Annual Meeting of the American Association for the Surgery of Trauma and the 4th World Trauma Congress, September 28, 2018, in San Diego, California.

Address for reprints: Michael J. Sise, MD, Trauma Service (MER62), Scripps Mercy Hospital, 4077 Fifth Ave, San Diego, CA 92103; email: sise.mike@scrippshealth.org.

© 2019 Lippincott Williams & Wilkins, Inc.